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eu*envedn <br />efMmrtluoml <br />Form CPF M 102-0: Campaign Finance Report <br />Municipal Form <br />bflicc of Campaign and Political Flnancc <br />City or Town of: <br />telly <br />Candidate k2//14 L J 727k'/7 Office <br />Please print or type all Information, except signatures, <br />Fill in dates: Month Day Year Month Day Year <br />B <br />Reporting Period Beginning / 7U / Lf Ending )'J/ 77% 1/0 /L` <br />Type of Report: (Check One) <br />8th day preceding ° 8th day preceding election 0 30th day following election 20th day of January <br />preliminary/primary <br />(Town or Special) <br />(Year -End Report)' <br />Pursuant to M,G,L„ Chapter 55: <br />1, I certify that I am a candidate for or hold Municipal Office, <br />2. 1 certify that 1 have not received any contributions, made any expenditures, or incurred any obligations during this <br />reporting period, and do not have a campaign fund in existence. <br />3, I certify that I do not have a political committee. <br />DATE <br />I. SIGNATURE <br />Signed under the penalties of perjury <br />11. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III. OFFICE SOUGHT <br />/ 0 0 <br />4- v �,�t/z' <br />-i. ,iI Z io d <br />Pado1 oy AAd <br />• <br />is ) <br />11/97 <br />0 <br />